National Health Services Planners Forum, Melbourne, Thursday 7 April 2011

1. National Health Services Planners Forum, Melbourne, Thursday 7 April 2011 Population health planning: prospects and possibilities Professor Helen Keleher Joint Chair in Health Equity, Monash University/Inner South Community Health Service

2. Population health aims • to improve the health and well-being of whole populations and • to reduce inequalities and inequities among and between specific population groups (ie, health equity) These are not ‘either-or’ aims

3. Health equity State population health plans: health equity not always defined, and often in less than robust terms Commonwealth reform documents also weak in defining health equity

4. NSW Health on health equity • Pursuing equity in health involves all efforts both within and beyond the health system aimed at improving life opportunities for people who are most disadvantaged, so that they have the best chance of achieving and maintaining good health. It implies a need for the redistribution of existing and new resources towards redressing these inequities (NSW Health 2004).

5. Commission on Social Determinants of Health on health equity • The unequal distribution of health-damaging experiences is not in any sense a ‘natural’ phenomenon but is the result of a toxic combination of poor social policies and programmes, unfair economic arrangements, and bad politics

6. Population health Some see population health as the aggregate of high-risk individuals - results in prevention strategies Population health is about determinants of health among populations and their characteristics The determinants of individual differences in risk are different to the determinants of differences between social groups.

7. Health systems and population health Health systems show variable capacity to determine how they impact on population health • Little effect in reducing inequality • Little capacity to show impact on most vulnerable

8. Social and health inequity are inter-twined • Housing stress • Childhood poverty • Family poverty • Food insecurity • Intergenerational unemployment • Social exclusion – marginality • Literacy • Chronic disease • Poor self-management • Poor nutrition • Lack of money for health care • Stress • Low health literacy

9. Population health planning • PHP is a strategy for integrated and responsive reforms in order to deliver better health outcomes in a defined catchment with a focus on social disadvantage. • PHP is more than health service planning and much more than ‘reaching the unreached in primary care’ • Population health plans are a type of master plan

10. Goals of population health planning Primary: to provide comprehensive plans to inform health improvement from a determinants approach Secondary: to improve the efficiency and effectiveness of the way that the health sector works with the other sectors that influence the determinants of health. Ultimately, PHPs should service the work that will reduce demand on hospitals

11. Examples of population health plans Statewide population health plans – to guide investment Community health profiles – to steer program work and intersectoral collaboration Others: Municipal Public Health Plans – specific to local government sphere Divisions of General Practice – specific to general practice

12. Indicators that count… • We have a critical need for population health indicators that can actually measure progress on health and social equity at catchment/community level • Meaningful indicators need to make sense to: • Policy makers, program managers • Community organisations, providers • Inter-sectoral partners

13. DATA: usually comes in a form of interest to researchers, but when analysed and interpreted, it becomes: KNOWLEDGE, and the process of acquiring and using that knowledge is empowering for communities so then we all acquire: WISDOM in making the right choices (even about expenditure and resource allocation) and the right use of knowledge, not just for ourselves but for the next generation. INFORMATION, which is of value to policy makers, program managers and other decision makers. But when information is translated into a form that is useful to the community it becomes:

14. Top-down or bottom-up planning? Planning should be as close to communities as practical involving local agencies, supported by governments Partnerships are critical: • Population health planning requires a wide range of sectors working together to address issues faced by their communities and meaningful engagement with those communities.

15. Medicare Locals - Healthy Communities Plans • ‘decisions and processes based on evidence and strong population health data will enable a stronger focus on prevention and early intervention, result in more appropriate service utilization, improved patient access and greater clinical and administrative efficiency’ (DoHA 2010, p 5).

16. Opportunities for Medicare Locals or catchment wide partnerships • Leadership in population health • Catalysts for knowledge brokerage • Knowledge translation • Learning how to build a multi-point knowledge network • Learn how to undertake comprehensive planning

17. Role of governments • Enabling of local efforts through policy and funding – find vehicles for implementation and pooled funding • Provider of data and guides to what data is available • Supporter of training of key staff • Set benchmarks in collaboration with the field of planners • Reward great efforts

18. What are the risks of we don’t do this? • Bad policy • More of the same • Widening inequities